Provider Demographics
NPI:1255305256
Name:MORA, DAVID SAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SAUL
Last Name:MORA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 CORPUS CHRISTI ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-3302
Mailing Address - Country:US
Mailing Address - Phone:956-726-1007
Mailing Address - Fax:
Practice Address - Street 1:1601 CORPUS CHRISTI ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-3302
Practice Address - Country:US
Practice Address - Phone:956-726-1007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3202TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019286601Medicaid
TX019286601Medicaid
TXT14913Medicare UPIN